1. _Psychical Hermaphroditism._[112]—The characteristic mark of this

degree of inversion of the sexual instinct is that, by the side of the pronounced sexual instinct and desire for the same sex, a desire toward the opposite sex is present; but the latter is much weaker and is manifested episodically only, while the homo-sexuality is primary, and, in time and intensity, forms the most striking feature of the vita sexualis. The hetero-sexual instinct may be but rudimentary, manifesting itself simply in unconscious (dream) life; or (episodically, at least) it may be powerfully exhibited. The sexual instinct toward the opposite sex may be strengthened by the exercise of will and self-control; by moral treatment, and possibly by hypnotic suggestion; by improvement of the constitution and the removal of neuroses (neurasthenia); but especially by abstinence from masturbation. However, there is always the danger that homo-sexual feelings, in that they are the most powerful, may become permanent, and lead to enduring and exclusive contrary sexual instinct. This is especially to be feared as a result of the influences of masturbation (just as in acquired inversion of the sexual instinct) and its neurasthenia and consequent exacerbations; and, further, it is to be found as a consequence of unfavorable experiences in sexual intercourse with persons of the opposite sex (defective feeling of pleasure in coitus, failure in coitus on account of weakness of erection and premature ejaculation, infection). On the other hand, it is possible that æsthetic and ethical sympathy with persons of the opposite sex may favor the development of hetero-sexual desires. Thus it happens that the individual, according to the predominance of favorable or unfavorable influences, experiences now hetero-sexual, now homo-sexual, feeling. It seems to me probable that such hermaphrodites from constitutional taint are not infrequent.[113] Since they attract very little attention socially, and since such secrets of married life are only exceptionally brought to the knowledge of the physician, it is at once apparent why this interesting and practically important transitional group to the group of absolute contrary sexuality, has thus far escaped scientific investigation. Many cases of frigiditas uxoris and mariti may possibly depend upon this anomaly. Sexual intercourse with the opposite sex is, in itself, possible. At any rate, in cases of this degree, no horror sexus alterius exists. Here is a fertile field for the application of medical and moral therapeutics (_v. infra_). The differential diagnosis from acquired contrary sexual instinct may present difficulties; for in such cases, as long as the vestiges of a normal sexual instinct are not absolutely lost, the actual symptoms are the same (_v. infra_). In the first degree, the sexual satisfaction of homo-sexual impulses consists in passive and mutual onanism and coitus inter femora. Case 106. _Psychical Hermaphroditism in a Lady._—Mrs. M., aged 44, exemplifies the fact that an inverted and a normal sexual instinct may be united in one person, be it in man or woman. The father of this lady was very musical, and very talented as an artist. He took life easily; and to his extraordinary beauty was added a great admiration for the opposite sex. After several apoplectic attacks, he died demented in an asylum. Father’s brother was neuro-psychopathic, and when a child was a somnambulist; and all his life he was afflicted with hyperæsthesia sexualis. Thus, although married and the father of married sons, he tried to seduce his niece, Mrs. M., with whom he was wildly in love, when she was eighteen years old. Father’s father was very eccentric and a distinguished actor. He first studied theology, but, as a result of partiality for the dramatic muse, he became an actor and singer. He committed excesses in baccho et venere; was a spendthrift and luxurious. He died at forty-nine, of apoplexia cerebri. Mother’s father and mother died of tuberculosis of the lungs. Mrs. M. was one of eleven children, of whom six are still living. Two brothers, who resembled the mother physically, died, at sixteen and twenty, of tuberculosis. A brother suffers with laryngeal phthisis. Four living sisters and Mrs. M. resemble the father physically, and the eldest is unmarried, very nervous, and shy of people. Two younger sisters are married, healthy, and have healthy children. The other is unmarried, and suffers with nervous complaints. Mrs. M. has four children, several of whom are delicate and neuropathic. The patient can tell nothing of importance concerning her childhood. She learned easily, and was æsthetically and poetically inclined. She was considered a little high-strung, and too much given to novel-reading and sentimentality. Her constitution was neuropathic, and she was extremely sensitive to changes of temperature, sometimes having annoying cutis anserina as a result of slight draughts. It is remarkable that one day, when she was about ten years old, she thought that her mother no longer loved her; and she put matches in her coffee to make herself really sick, that she might thus excite her mother’s love for her. Puberty began, without difficulty, at the age of eleven. Thereafter the menses were regular. Before the time of puberty sexuality manifested itself, and, according to the opinion of the patient, its promptings have been abnormally intense all her life. The first feelings and impulses were decidedly inverted. She conceived a passionate but platonic love for a young lady. She wrote verses and sonnets to her, and was perfectly happy if she could admire “the entrancing charms” of her goddess in the bath, or steal a glimpse of her neck, shoulders, and breast while she was dressing. The wild impulse to touch these physical charms was always overcome. While a young girl, she had actually been in love with Madonnas of Raphael and Guido Reni. In all kinds of weather she would run after pretty girls and ladies for hours at a time, admiring their beauty, losing no opportunity to please them, offering them bouquets, etc. The patient asserted that, until the age of nineteen, she was absolutely without a suspicion of a difference of sex; because she had been educated as in a cloister by a very prudish aunt, who was an old maid. As a result of this great ignorance, the patient became the victim of a man who was passionately in love with her, and who had coitus with her by means of stratagem. She became the wife of this man, bore one child, and lived an “eccentric” sexual life with him. She felt perfectly satisfied with married intercourse. After a few years she became a widow. Since then, women have again been the object of her love, primarily, as the patient thinks, from fear of the results of sexual intercourse with a man. At twenty-seven, second marriage, without love, to a phthisical husband. Patient was three times confined, and fulfilled her maternal duties. Her physical health failed, and in the later years of this married life she had an increasing aversion for her husband, partly due to a sense of his disease, though, at the same time, there was constantly present an intense desire for sexual indulgence. Three years after the death of her second husband, the patient discovered the fact that her nine-year-old daughter, by her first husband, was given to masturbation, and that she was failing in physical health. The patient read of this vice, and could not overcome the impulse to indulge in the practice, becoming, in consequence, an onanist. She is unable to bring herself to give the details of this period of her life. She says that she was frightfully excited sexually, and had to send her daughters from home to save them from terrible consequences; but the two boys she was able to keep at home. Patient became neurasthenic ex masturbatione (spinal irritation, feeling of pressure in head, weariness, lack of mental control), and, at times, had dysthymia and painful tædium vitæ. Her sexual feeling would be directed at one time to women, at another to men. She was able to restrain herself, and suffered much from abstinence, especially because, on account of her neurasthenic troubles, she sought to obtain relief in masturbation, though only in case of great necessity. At the present time, though forty-four years old, and menstruating regularly, she suffers intensely with a passion for a young man whose presence she cannot avoid on account of the exigencies of occupation. Patient presents nothing remarkable in external appearance. She is gracefully formed, but the muscular system is not strongly developed. Pelvis is, in all respects, that of a female, but the arms and legs are decidedly large and of masculine form. Ladies’ shoes do not fit her, but, being opposed to exciting attention, she forces her feet into female shoes, and they are, therefore, much deformed. Genitals normally developed, and present no other abnormality than descent of the uterus, with hypertrophy of the vaginal portion. On thorough examination it is seen that the patient is essentially homo-sexual, and that the desire for the opposite sex is but episodical and sensual. Thus, at present, she suffers intensely with sexual desires for every man with whom she comes in contact, but it is a more refined and higher pleasure for her to imprint a kiss on the soft, round cheek of a maiden. This pleasure is one she often enjoys, because she is much beloved as the “dear aunt” by all the “sweet creatures”; for she voluntarily does them the most various chivalrous favors, always feeling herself at such times as a man. Case 107. _Contrary Sexual Instinct with Sexual Satisfaction in Hetero-Sexual Intercourse._—Mr. Z., aged 36, Hollander, consulted me, in 1888, on account of an anomaly of his sexual feelings, which had become a matter of anxiety to him in connection with an intended marriage. Patient’s father was neuropathic, and suffered with nightmare and night-terrors. Grandfather was mentally unsound; father’s brother an idiot. Patient’s mother and her family were healthy and normal mentally. The patient had four sisters and one brother, the latter being subject to moral insanity. Three sisters are healthy, and living happy married lives. As a child, the patient was weak, nervous, and subject to night-terrors, like his father; but he never had any severe sickness except coxitis, as a result of which he limps slightly. Sexual impulses were manifested early. At eight, without any teaching, he began to masturbate. From his fourteenth year, ejaculation. He was mentally well endowed, and his principal interest was in art and literature. He was always weak muscularly, and had no inclination for boyish sports and later for manly occupations. He had a certain interest for female _toilettes_, ornaments, and occupations. From the time of puberty the patient noticed in himself an inexplicable inclination toward male persons. Youths of the lowest classes were especially attractive to him. Cavalrymen especially excited his interest. He experienced a lustful desire to press himself against such individuals from behind. Occasionally, in crowds, it was possible for him to do this; and in such an event an intense feeling of pleasure passed over him. After his twenty-second year, on such occasions, he now and then had an ejaculation. From that time ejaculation occurred when a sympathetic man laid his hand on the patient’s thigh. He was now in great anxiety lest he might sometime assault a man sexually. People of the lower classes, wearing tight, brown trousers, were especially dangerous for him. His greatest pleasure would be: to embrace such a man and press himself on him; but, unfortunately, the morality of his country did not allow such a thing. Pederasty seemed disgusting to him. It gave him great pleasure to gain a sight of the genitals of males. He was always compelled to look at the genitals of every man he met. In circuses, theatres, etc., only male performers interested him. Patient has never noticed any inclination for women. He does not avoid them, even dances with them on occasion, but he never feels the slightest sensual excitation under such circumstances. At the age of twenty-eight the patient was neurasthenic as a result of his excessive masturbation. Then frequent pollutions in sleep occurred, which weakened him very much. It was only occasionally that he dreamed of men when he had pollutions; and never of women. A lascivious dream-picture (pederasty) had occurred but once. He dreamed of dying-scenes, of being attacked by dogs, etc. After these, as before, he suffered with great libido sexualis. Often there came up before him such lascivious thoughts as gloating over the death of animals in the slaughter-house, or allowing himself to be whipped by boys; but he always overcame such desires, and also the impulse to dress in a military uniform. In order to cure himself of masturbation, and to thoroughly satisfy his libido, he determined to frequent brothels. He first attempted sexual intercourse with a woman when twenty-one, after over-indulgence in wine. The beauty of the female form, and female nudity in general, made no impression on him. However, he was able to enjoy the act of coitus, and thereafter he visited brothels regularly for “purposes of health.” From this time he took great pleasure in hearing men tell stories of their sexual relations with the opposite sex. Ideas of flagellation would also come to him while in a brothel, but the retention of such fancies was not essential for the performance of coitus. He considered sexual intercourse with prostitutes only a remedy against the desire for masturbation and men,—a kind of safety-valve to prevent compromising himself with some man. The patient now wishes to marry, but fears not only that he could have no love for a decent woman, but also that he might be impotent for intercourse with one. Hence his thought and need of medical advice. The patient is very intelligent, and is, in all respects, of masculine appearance. In dress and manner he presents nothing that would attract attention. Gait, voice, and skeleton,—the pelvis especially,—masculine in character. Genitals of normal development. The normal growth of hair for a male is abundant. The patient’s relatives and friends have not the slightest suspicion of his sexual anomalies. In his inverted sexual fancies, he has never felt himself in the _rôle_ of a woman toward a man. For some years he has been entirely free from neurasthenic troubles. The question as to whether he considered himself a subject of congenital inversion of sexual instinct he could not answer. It seems probable that there was a congenital weak inclination for the opposite sex, with a greater one for the same sex, which, as a result of early masturbation in consequence of the homo-sexual instinct, was still more weakened, but not reduced to _nil_. With the cessation of masturbation, the feeling for women became in a measure more natural, but only in a coarsely sensual way. Since the patient explained that, for reasons of family and business, it was necessary for him to marry, it was impossible to avoid this delicate question. Fortunately, the patient limited his inquiries to the question as to his virility as a husband; and it was necessary to reply that he was virile, and that he would probably be so in conjugal intercourse with the wife of his choice,—at least, if she were to be in mental sympathy with him; besides, that he could at all times improve his power by exercising his imagination in the right direction. The main thing was to strengthen the sexual inclination for the opposite sex, which was defective, but not absolutely wanting. This could be done by avoiding and opposing all homo-sexual feelings and impulses, possibly with the help of the artificial inhibitory influences of hypnotic suggestion (removal of homo-sexual desires by suggestion); by the excitation and exercise of normal sexual desires and impulses; by complete abstinence from masturbation, and eradication of the remnants of the neurasthenic condition of the nervous system by means of hydrotherapy, and possibly general faradization. I am indebted to a physician, aged thirty, for the following autobiography, which in another respect is noteworthy:— Case 108. _Mental Hermaphroditism; Abortive Contrary Sexual Instinct._—“In my ancestry I am somewhat predisposed hereditarily. My grandfather on my father’s side was a high-liver and a speculator. My father was a man of character, but for more than thirty years he has suffered with folie circulaire, without, however, being much hindered by it in business. My mother, like her father before her, suffers with stenocardiac attacks. My mother’s father and brother are said to have been sexually hyperæsthetic. My only sister, about nine years older than myself, was twice subject to attacks of eclampsia, and during puberty was religiously exalted, and probably also sexually hyperæsthetic. During many years she had to suffer with a severe hysterical neurosis, but she is now completely well. “As an only son, and born late, I was the apple of my mother’s eye; and I have her indefatigable care to thank that I survived childhood, after having passed through all the possible diseases of children (hydrocephalus, measles, croup, small-pox, and, at thirteen, chronic intestinal catarrh that lasted a year). My mother, being herself very religious, raised me, without spoiling me, in a religious way, and implanted in me, as the guiding moral principle, an unyielding devotion to duty, which was further carried to an extreme in me by a teacher whom I still call a friend. Owing to my delicate health, my childhood, in greater part, was spent in bed; and I was thus given to quiet occupations, especially reading; and thus as a boy I came to be—if not _blasé_—premature at least. As early as eight or nine the parts of books that excited me most were those where injuries or operations that had to be endured by beautiful girls or ladies, were described. Thus I was thrown into great excitement by a story in which was pictured a maiden that had run a thorn into her foot, with a boy taking it out for her. Indeed, every time that I looked upon this picture, which was in nowise lascivious, I had an erection. Whenever possible, I went to see chickens killed; and if I had missed that, I looked at the spots of blood, and stroked the warm bodies of the birds, with pleasurable shudders. I would emphasize the fact that I have always been a great lover of animals, and have felt disgust and pity while killing larger animals, and even in the vivisection of frogs. “The killing of chickens is still a great sexual stimulus for me, and especially holding them, during which I have palpitation of the heart and precordial oppression. It is of interest that my father had a passion for binding together the hands of girls and young women. “I think that another of my sexual abnormalities is attributable to this strain of cruelty. As I shall clearly describe later, one of my favorite games was that of an improvised doll-theatre, where I prescribed the parts of my companions. Almost always it was a young girl who, at the command of her papa, whom I represented, had to have a painful operation done on her foot. The more the girl cried, the more satisfaction I had. How I came to hit upon the foot as the constant object of operation will be seen from the following: When a very young boy, I happened to see my eldest sister change her stockings. When she hastily hid her feet, my attention was attracted, and immediately the sight of her bare feet to the ankles came to be the ideal of my longing. Naturally, this made my sister very careful; and thus there was occasioned a constant quarrel, which, on my part, was kept up with all the wiles of cunning and flattery, and with even explosions of anger, until my seventeenth year. In other respects my sister was very indifferent. Indeed, her kiss is repugnant to me. _Faute de mieux_, I made use of the feet of servants; masculine feet had no effect on me. My greatest desire would have been to cut the nails, or, _sit venia verbo_, the corns, on the beautiful foot of a woman. My lustful dreams were concerned with these things. Indeed, I applied myself to the study of medicine really in the expectation of gaining an opportunity to satisfy my desires, or cure them. Thank God, I attained the latter. After undertaking the first dissection of the lower extremity of a female, this unhappy desire was removed from me. I was unhappy because I was always deeply ashamed of this impulse. I think I may spare further details concerning it, since this peculiar enthusiasm, which even inspired me to write verses, has been sufficiently described by others. “Now, concerning the last phase of my sexual errors: I was about thirteen, and had just begun to mature, when a school-mate, who happened to be our guest, teased me one night by kicking me with his bare feet under the covers. I seized his foot, and immediately became greatly excited, and had a pollution after it,—the first that I had. The boy was peculiarly girlish in form, and was also mentally effeminate. Too, another comrade who had very small and delicate hands and feet, whom I once saw in a bath, caused unusual excitement in me. I thought it a great piece of good fortune to be in bed with either of these, though any nearer sexual intercourse than embracing them never came into my mind. Moreover, I always thrust such thoughts aside with aversion. Some years later, when about sixteen or eighteen, I made the acquaintance of two other boys that awakened my sexual feeling. When I played with either of these, I immediately had an erection. Both were very energetic and lively, but delicately formed and child-like. At the occurrence of puberty I lost interest in both of them, though a warm friendship was preserved. I should never have allowed myself to have indulged in vicious practices with them. “When I went to the University, I forgot completely these errors of my libido sexualis, and from principle I kept from sexual intercourse until I was twenty-four, in spite of the contempt of my companions. When pollutions became too frequent, and I began to fear cerebral neurasthenia ex abstinentia, I gave myself up to normal sexual indulgence, though somewhat mechanically; and it was, of course, very beneficial to me. “The especial field of work to which I have devoted myself is responsible for the fact that I am almost impotent with puellis publicis, and also for the fact that the naked form of a woman disgusts rather than excites me. The act always satisfies me the most, if, during it, I can keep the vision of the face before me; but since, on the other hand, the idea that the girl near me is enjoyed by another is unbearable, for years I have found it absolutely necessary for my mental comfort, in spite of the pecuniary sacrifice, to keep a mistress, and, indeed, a virgin. Otherwise the most terrible jealousy made me absolutely incapable of work. I must also mention that, at thirteen, I fell in love platonically for the first time; and since then I have often pined in chaste love. What distinguishes my case from all others is the fact that I have never once masturbated in my life. “Some weeks ago, in sleep, I was frightened by a dream of a naked boy, from which I awoke with an erection. In conclusion, I venture to undertake the difficult task of describing my present condition: Medium height, gracefully formed. Skull dolichocephalic, with prominence in the occipital region; circumference, 59 centimetres; frontal prominence marked; glance somewhat neuropathic; pupils medium; teeth very defective; musculature strong and tense; abundant hair, blonde. Varicocele on the left side; frenulum too short, which hindered me in coitus. I severed it myself three years ago. Since then ejaculation is retarded, and pleasurable feeling much diminished. Temperament choleric. Quick of comprehension; good at drawing conclusions; energetic; for one hereditarily predisposed, very persevering. I learn languages easily, and have a good ear for music, but otherwise I have no talent for the arts. I am always ambitious to do my duty, but I am constantly troubled with tædium vitæ, and only kept from attempts at suicide by my religion and the thought of my mother. Otherwise I am a typical candidate for suicide. I am ambitious, jealous, have a fear of paralysis; left-handed. I am filled with socialistic ideas. I like adventures, and I am courageous. I have decided never to marry.” Case 109. _Psychical Hermaphroditism. Autobiography._—“I was born in